Emerging emergency medicine

Emerging emergency medicine : Turning points and Burning points : Emerging emergency medicine : Turning points and Burning points Dr. Venugopalan.P.P Chief, Institute of emergency medicine MIMS Calicut
Objectives: Objectives E M background in India What others think about EM Turning points during emergence Burning points Lesson learnt
Scenario: Scenario Dr.Eqbal is fresh graduate scored excellent rank in NEET exam and he is very much interested to join MD EM . He seeks a second opinion with his role model professors. Medicine professor advised him “Don’t take such dirty specialty”. Microbiology professor “ What is it…I am not aware of such specialty “
1# Concept : 1# Concept What is emergency medicine Where exactly the boundaries Know your strength and weakness Name of the specialty Casualty E M E R G E C Y M E D I C I N E
Emergency Medicine : Emergency Medicine Initial evaluation, treatment and disposition of any person at any time for any symptom, event or disorder deemed by the person or someone acting on his or her behalf to require expeditious medical, surgical or psychiatric attention . ACEM
PowerPoint Presentation: Specialty has been recognized by MCI on 21st July 2009 It is not Critical care It is not Anesthesiology
PowerPoint Presentation: Take opinions from those persons who know about it ..
Scenario: Scenario Dr.Vineetha knows about the speciality of Emergency medicine . She also knows some courses are available. She was so much worried about the placement , job responsibilities payments ,recognition etc…
2# Emergency Physician : 2# Emergency Physician Qualification Academics and visibility Faculty from other specialties Involve as much as
Emergency Physician : Emergency Physician A specialist who has been trained to engage in the immediate initial recognition, evaluation and disposition of patient with acute illness and injury..
Emergency Physician: Emergency Physician ER Physicians do not usually provide long term or continuous care but they diagnose a wide range of diseases and perform interventions to stabilize the patient
Emergency Physician: Emergency Physician Attitude Aptitude Alertness Aggressiveness Adaptability Awareness Accomplishment 7 A
Qualifications: Qualifications MD MCI recognized other specialists like surgery anesthesia ; Medicine ; Pulmonologist DNB MEM MCEM;FCEM Fellowships PGDEM Quality Mo R e D Ema N d Less people
Scenario: Scenario 55years gentle man presented to emergency department with giddiness and tachypnea at 2 AM. Known case of CAD and APD, had stent and on anticoagulant P A to state transport minister and he was not even willing to do initial evaluation. He want to see his cardiologist . Cardiologist is not taking phone More than 10 bystanders around
3# People : 3# People They are not much bothered about who you are ! 1000 people… more than 10,000 ideas Competency and care up to their expectations Quality and professionalism Ethics , Transparency and Truthfulness Passionate always
Scenario: Scenario 23yr old female brought to ED following RTA. Had suspected C-spine injury , # Humerus and # Femur Attending did Primary survey and Secondary survey as per ATLS protocols Later new bystanders started agitation and abusive language for tearing dresses for exposure in Primary survey
#4 Patients : #4 Patients Have a problem and sometimes many …. Distress Rewards are …how fast you make them comfortable Need physical , physiological and psychological resuscitation Culture ,Race and Religion Bystanders are the real problem ….
Scenario: Scenario 25 year old lady present abnormal behavior and hyperventilation . Case was referred from rural Kerala. Vitals normal. 12 bystander crowding around patient. Few of the shouting. Some are on mobile phone . Chaotic casualty.
#5Premise : #5Premise ER is the front office Good reception lead good care lead to comfort and confidence Plan ,Performance and Perfection Implement what exactly you want Be live …save lives …
PowerPoint Presentation: Pediatric Emergency Medicine
Family system: Family system Joint family Nuclear family Ultra Nuclear
Scenario: Scenario 5 bedded rural casualty, 1 OT, No CT facility 3 doctors, 6 Nurses ,One ambulance and 2 ambulance assistants 8 patients brought to casualty following a collision of Jeep versus Autorickshaw 5 Walking patients , 1 case with fracture femur of Hypotension, 1 case with facio -maxillary injury with obstructed airway and one case fracture dislocation of shoulder
#6 Team: #6 Team Doctors, Nurses, Paramedics , Ambulance assistants ,Security …. Training, modulation and empowerment Team work is the success
You can win…..: You can win…..
When resources are exhausted …: When resources are exhausted …
Scenario: Scenario 78 year old lady ,Known case of DM, CKD,CAD and COPD presented to ED with SOB and Signs of Sepsis Attending EP initiated early stabilization and contacted different consultants Medical ICU beds are full except crash bed Consultants are not very keen to take case
#7 Destination: #7 Destination When destination is not clear … Overcrowding Dumping No man area Multisystem cases and Poly trauma Protocol based practice
Scenario: Scenario 37 year old gentleman brought to Ed with shortness of breath , palpitation and dizziness Vital Pulse 210 / mt reg. BP 110 ,SpO2 94 RA ECG – supra ventricular Tachy Not responding to Vagal maneuver and responds to one dose of adenosine and called cardiologist for expert opinion He shouted to EP like anything and asked to do the rest of the management as well
#8 Consultants: #8 Consultants Supportive Incompatible Lazy Egoistic Money Over work /Burn out Evidence based Medicine Do for the best interest of patient
Scenario: Scenario 25 year old male presented with Tachypnea and pleuritic chest pain. He was just travelled from Washington yesterday. PGY2 order D- Dimer . PGY 3 objected and they are in Arguments
#9 Academics : #9 Academics Regular academics Multiple levels Different modalities Teaching is the best way to learn
Scenario: Scenario A corporate Emergency department claimed to do good works . They reported the they treated 65,000 cases per year. Resuscitated many cases. NABH auditors visited in the department declared that department is not meet the standards
#10 Quality assurance : #10 Quality assurance Regular follow up Documentation Know about the errors and its chances Fix measurable Parameters , process and protocol Errors Audit Only way to get into next level
PowerPoint Presentation: Assessment-Diagnosis-Treatment-Management-Disposition Triage Admit Discharge EMS Patient Presentation ED Design Triage Cueing Over crowding Information Gap Lab errors Report Delay Authority Gradient Orphaned Pt Team work problem Transition of Care Resource Constrain Sense Making Affective state Radiology Error Fatigue & Shift work Cognitive properties of the mind Violation producing factors Procedural factors Medication errors Inadequate Discharge Plan Long waiting time For Bed Follow up failures Sources of Failures and Errors in ED
PowerPoint Presentation: Acad Emerg Med. 2000 Nov;7(11):1204-22. Promoting patient safety and preventing medical error in emergency departments. Schenkel S . Author information Abstract An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice. PMID: 11073469 [ PubMed - indexed for MEDLINE] 108000 preventable deaths from iatrogenic injuries per year 1 in 50 hospitalized patients experiences preventable adverse events 3% from ER
PowerPoint Presentation: Finally ….. The most important Tool of ER
PowerPoint Presentation: Communication Communication Communication Communication
Summarizing…. : Summarizing…. ….Look at the picture
PowerPoint Presentation: Look and relook
PowerPoint Presentation: E M E R G I N G E M E R G E N C Y MEDICINE Thank you so much www.drvenu.net